Presumptive Eligibility

Presumptive eligibility (PE) provides Medicaid for a limited time while a formal Medicaid eligibility determination is being made by the Iowa Department of Human Services (DHS). The goal of the presumptive eligibility process is to offer immediate health care coverage to people likely to be Medicaid eligible, before there has been a full Medicaid determination. Based on a household’s statements regarding their circumstances and income, a qualified entity (QE) can enter the applicant’s information into the Medicaid Presumptive Eligibility Portal (MPEP). If determined to be eligible, the applicant will have temporary Medicaid eligibility during the presumptive eligibility period. A “qualified entity” or QE is generally defined as an enrolled Iowa Medicaid provider who is certified by DHS and is authorized to make presumptive eligibility determinations. A provider who meets the QE requirements must agree to the terms and conditions in an electronically maintained Memorandum of Understanding (MOU).